Introduction
The Perception of Risk of Heart Disease Scale (PRHDS) is a vital instrument designed to measure an individual's perception of their risk of developing heart disease. First introduced in 2008 by Ali Ahmad Ammouri and Geri Budesheim Neuberger, the PRHDS has since become an indispensable tool in cardiovascular research and health psychology. Consequently, its primary validation study has amassed over 80 citations, underscoring its significant impact and widespread adoption within the scientific and clinical research community.
This article serves as an expert guide, meticulously detailing the PRHDS's key features, clinical and research applications, and research value. Ultimately, it provides researchers and clinicians with the necessary insights for effectively incorporating this powerful instrument into their work.
Key Features of the Perception of Risk of Heart Disease Scale (PRHDS)
Purpose and Use
The primary purpose of the PRHDS is to measure an individual's perception of their risk of developing heart disease. It assesses feelings and beliefs about heart disease, covering aspects of fear, likelihood, and ambiguity.
Target Population
The PRHDS targets adults aged 18 and older. Specifically, the scale is suitable for:
Young Adults (18-24 years)Middle-Aged Adults (25-44 years)Older Adults (45-64 years)Seniors (65+ years)Furthermore, it is designed for adults with a risk of getting heart disease.
Structure
The PRHDS contains 20 items divided into three distinct subscales within the cardiology domain:
Dread Risk: Measures the emotional fear and worry associated with heart disease.Risk: Assesses the perceived likelihood or probability of experiencing a heart event.Unknown Risk: Evaluates the feeling of ambiguity or lack of clarity surrounding heart disease threats.Scoring Method
Scoring the PRHDS involves a straightforward, additive approach:
Each of the 20 items is rated on a 4-point Likert scale (Strongly disagree = 1, Disagree = 2, Agree = 3, Strongly agree = 4).12 items are negatively worded and must be reverse-scored before calculation (items: 6, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20).To score the instrument, item scores are summed for each subscale, as well as across subscales for a total scale score.It is important to note that the original development/validation study did not define diagnostic cut-off values or severity categories for the PRHDS. Typically, the scale is used as a continuous measure of perception, not for clinical diagnosis with a cut-off. Higher scores simply reflect a greater perceived risk of developing heart disease.
Administration Format
The PRHDS typically requires 15 to 30 minutes to complete. Healthcare teams can administer the questionnaire in multiple formats, including:
Paper-basedDigital (Online)Interview (In-person)Phone/Video CallMoreover, no special training is required, as the scale is self-administered.
Applications of the Perception of Risk of Heart Disease Scale (PRHDS)
The PRHDS has several key applications in clinical and research settings:
Screening: It helps identify individuals with a high perception of cardiovascular risk.Monitoring: Clinicians can use it for monitoring risk perception over time.Research: It serves as a reliable endpoint for studies on heart disease prevention and health beliefs.Languages and availability
Due to its global adoption, the PRHDS is available in several languages, including:
EnglishItalianThe PRHDS is not free for unrestricted use. Permission from the publisher (Springer Publishing Company) is required for its use, as it is a proprietary instrument. Therefore, researchers and clinicians must obtain formal permission before administering the scale in clinical or research settings.
Reliability and Validity
The PRHDS is recognized as a moderately reliable and valid instrument for assessing cardiovascular risk perception. Its psychometric soundness is well-documented, with a Cronbach's alpha for the total scale of 0.80 and subscales ranging from 0.68 to 0.80, indicating acceptable to good internal consistency. Additionally, the test-retest reliability for the subscales ranges from 0.61 to 0.76.
Key validation resources include:
The Original Validation Study linkValidation of the Brief Italian Version linkLimitations and Considerations
Despite its strengths, the PRHDS has a few limitations:
Self-report measure: Respondents may be influenced by personal bias or social desirability.Cultural Bias: The scale may require further adaptation for diverse populations.Language Barriers: Availability is currently limited to English and Italian.Narrow Focus: The scale specifically covers cardiology domains and does not assess other health anxieties.Other Versions And Related Questionnaires
Researchers and clinicians should be aware of other versions of the questionnaire:
Brief Italian Version:A 6-item unidimensional version has been developed and validated for the Italian population.Additionally, the PRHDS can be used alongside complementary assessment tools, such as:
Health Promotion Lifestyle Profile II (HPLP II)Heart Disease Fact QuestionnaireAttitudes and Beliefs about Cardiovascular Disease Risk QuestionnaireAdditional Resources
The Original Validation Study linkYou can access the questionnaire as a PDF through this linkValidation of the Brief Italian Version linkFor inquiries, contact Ali A. Ammouri (School of Nursing, Hashemite University, Zarqa, Jordan) via email: aammouri@hu.edu.joFrequently Asked Questions (FAQ)
1. Who can use the PRHDS?
Clinicians, researchers, and healthcare providers use the PRHDS for adults aged 18 and older, particularly those with risk factors for heart disease.
2. How long does it take to complete the PRHDS?
Patients typically complete the 20-item questionnaire in 15 to 30 minutes, making it feasible for use in clinical and research settings.
3. How is the PRHDS administered?
Healthcare teams can administer the questionnaire via paper-based, digital (online), in-person interview, or phone/video call formats, offering flexibility in usage.
4. Is there any cost to using the PRHDS?
The PRHDS is not free. It requires permission from the publisher (Springer Publishing Company) for use, as it is a proprietary instrument.
A Word from ResRef about Perception of Risk of Heart Disease Scale (PRHDS)
The PRHDS is a foundational tool for understanding how individuals perceive their susceptibility to heart disease. Its strength lies in its multi-dimensional approach (Dread, Risk, Unknown). While the original study recommends further validation across diverse groups, recent adaptations (e.g., the Italian brief version) demonstrate its ongoing relevance and adaptability in cardiovascular research.
References
Ammouri, A. A., & Neuberger, G. (2008). The perception of risk of heart disease scale: Development and psychometric analysis. Journal of Nursing Measurement, 16(2), 83–97. linkRosa, D., Pengo Martino, F., Adorni, R., Bilo, G., Parati, G., & Steca, P. (2023). Psychometric properties of a brief version of the Perception of Risk of Heart Disease Scale in an Italian sample. High Blood Pressure & Cardiovascular Prevention, 30(5), 475–484. link